Risk Factors for Overdose in Treatment-Seeking Youth With Substance Use Disorders

Abstract

Objective Overdoses (OD) are among the leading causes of death in youth with substance use disorders (SUDs). We aimed to identify the prevalence of OD and characteristics associated with a history of OD in youth presenting for SUD outpatient care. Methods Systematic retrospective medical record review of consecutive psychiatric and SUD evaluations for patients age 16 to 26 years at entry into an outpatient SUD treatment program for youth. Unintentional OD was defined as substance use without intention of self-harm that was associated with a significant impairment in level of consciousness. Intentional OD was defined as ingestion of a substance that was reported as a suicide attempt. T-tests, Pearson’s chi-square, and Fisher’s exact tests were performed to evaluate characteristics associated with a history of OD. Results We examined the medical records of 200 patients (157 males and 43 females) with mean age 20.2 (±) 2.8 years. At intake 58 patients (29%) had a history of OD and 62% of those patients had a history of unintentional OD only (n=36). Youth with ≥2 SUDs were 3 times more likely to have a history of OD compared to youth with 1 SUD (all p<0.05). Compared to those without a history of OD those with an OD were more likely to be female and have lifetime histories of: alcohol, cocaine, amphetamine, anxiety, depressive, and/or eating disorders (all p<0.05). Conclusion High rates of OD exist in treatment-seeking youth with SUD. OD was associated with more SUD and psychiatric co-morbidity.

Risk Factors for Overdose in Young People Who Received Substance Use Disorder Treatment

“…A patient was defined as being “in treatment” at the time of OD if they attended an appointment within the month prior to OD. Consistent with prior work, unintentional OD was defined as patient report of substance use without intention of self‐harm that was associated with significant impairment in level of consciousness. Intentional OD was defined as patient report of an ingestion of any substance with the deliberate intention of self‐harm that was reported as a suicide attempt.…”

“…Consistent with prior work, unintentional OD was defined as patient report of substance use without intention of self‐harm that was associated with significant impairment in level of consciousness. Intentional OD was defined as patient report of an ingestion of any substance with the deliberate intention of self‐harm that was reported as a suicide attempt. A death was classified as a presumed OD based on collateral from family or medical record regarding the circumstances surrounding the death and the patient's substance use history.…”

“…Young people ages 16 to 26 years of age at intake assessment who had a diagnosis of SUD (substance abuse or dependence, Diagnostic and Statistical Manual of Mental Disorders , 4th edition, Text Revision criteria) were included in the original sample. Detailed study methodology has been previously described …”

“…Risk factors for OD in young people that have been replicated include substance‐specific factors such as use of heroin, methamphetamine, tranquilizers, and cocaine . History of intravenous drug use and history of witnessing an individual OD are also replicated risk factors in young people. We recently examined the OD risk factors reported, retrospectively, in a more heterogeneous sample of young people with SUD at initial evaluation for SUD treatment .…”

“…History of intravenous drug use and history of witnessing an individual OD are also replicated risk factors in young people. We recently examined the OD risk factors reported, retrospectively, in a more heterogeneous sample of young people with SUD at initial evaluation for SUD treatment . We found that in addition to characteristics associated with more severe SUD, psychopathology in general, and mood disorders in particular, were associated with a history of nonfatal OD.…”